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Am J Geriatr Psychiatry. 2014 Nov;22(11):1075-82. doi: 10.1016/j.jagp.2014.01.015. Epub 2014 Feb 2.

Prevalence and correlates of renal disease in older lithium users: a population-based study.

Author information

1
Department of Psychiatry, McGill University, Montreal, Quebec, Canada. Electronic address: soham.rej@mail.mcgill.ca.
2
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
3
Department of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.
4
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
5
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada.
6
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

Lithium is an important treatment for mood disorders, but concern about its association with renal disease has contributed to its limited use, particularly in older adults. Because high-quality evidence examining renal disease in this population is lacking, this study aims to quantify the prevalence and identify clinical correlates of renal disease in geriatric lithium users.

METHODS:

In a population-based cross-sectional study on 2,480 lithium users aged 70 or more years, the authors searched the provincial administrative health data from Ontario, Canada between April 1, 2005 and March 31, 2011. Prevalence of chronic kidney disease (CKD), acute kidney injury (AKI), and nephrogenic diabetes insipidus (NDI) was measured using International Classification of Diseases, Tenth Revision codes. Logistic regression analyses were used to identify independent correlates of renal disease.

RESULTS:

The 6-year prevalence rates of CKD, AKI, and NDI were 13.9%, 1.3%, and 3.0%, respectively. Hypertension (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.50-2.79), diabetes mellitus (OR: 1.86; 95% CI: 1.45-2.38), ischemic heart disease (OR: 1.65; 95% CI: 1.24-2.20), NDI (OR: 2.54; 95% CI: 1.47-4.40), AKI (OR: 11.7; 95% CI: 5.26-26.1), lithium use for more than 2 years (OR: 1.71; 95% CI: 1.05-2.81), loop diuretic use (OR: 1.74; 95% CI: 1.26-2.41), hydrochlorothiazide use (OR: 1.48; 95% CI: 1.07-2.05), and atypical antipsychotic use (OR: 1.49; 95% CI: 1.17-1.89) were all independently associated with CKD.

CONCLUSION:

Older lithium users have high rates of CKD. Lithium use duration was independently associated with CKD. Longitudinal studies including individuals without lithium exposure will be necessary to confirm whether lithium is indeed a risk factor for CKD in older adults.

KEYWORDS:

Lithium; acute kidney disease; chronic kidney disease; drug safety; geriatric; nephrogenic diabetes insipidus

PMID:
24566239
DOI:
10.1016/j.jagp.2014.01.015
[Indexed for MEDLINE]

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